Transgender bias alleged over ‘ archaic’ consent rules

A transgender B. C. man is alleging that the province discriminates against people seeking gender- reassignment surgery by forcing them to ask the Ministry of Health for approval before they can go under the knife.

Jackson Rae Flagg’s complaint to the B. C. Human Rights Tribunal argues that the government unfairly puts itself between transgender patients and their doctors, even though it acknowledges that gender-reassignment surgeries are medically necessary.

Before he could get MSP funding for breast- removal and chest contouring surgery, Flagg’s doctor had to get the ministry’s permission to refer him to an assessing physician, who then made a recommendation to the provincial gender- reassignment surgical review committee about whether Flagg truly had “persistent, well- documented gender dysphoria” and was physically and mentally ready to take the plunge. That committee had the final say on whether MSP would pay for the procedure.

In contrast, a man who required a breast reduction to treat gynecomastia, or benign breast tissue enlargement, would simply need to be referred to a specialist by his family doctor in order to get approved for coverage.

Flagg described the process he had to go through as “archaic.”

“If you think about many of the other health services that the Ministry of Health provides, there isn’t a lot of intervention by the state,” he said.

Flagg felt his privacy was violated when the physician who assessed him passed on private information about his medical and psychological history to the government committee.

“The application form that the ministry provides to the doctors to fill out is very, very invasive,” Flagg said. “It talks about all these sensitive things that have nothing to do with gender, and it’s not the business of the government.”

In the time since Flagg applied for coverage in 2012, the process for getting MSP approval has simplified somewhat, and the gender- reassignment surgical review committee has been eliminated.

However, patients still require ministry approval to be referred for assessment, and the ministry’s Medical Beneficiary Branch now has the last word on whether funding is approved, based on the standards of care laid out by the World Professional Association for Transgender Health. A ministry spokeswoman said she wasn’t able to say how much, if any, personal patient information is passed on to the Medical Beneficiary Branch.

Flagg’s complaint was officially accepted by the rights tribunal for filing last week. Advocates for transgender rights say it raises important questions about how transgender patients are treated.

UBC student Lucas Wilson has had reassignment surgery on his chest and genitals, as well as a hysterectomy, and describes the steps he went through to get MSP coverage as “repetitive gatekeeping.”

“By the time a person actually wants to access gender- reassignment surgery, they’ve got a pretty good idea of what they want and what they need for their bodies. A lot of the steps, from my perspective, are a lot of the same things said to different people in different places at different times,” he said.

“The effect is to draw out the process, which is irritating for a transgender person who feels that their bodies aren’t being treated like anybody else’s bodies would be.”

In fact, Wilson became so frustrated by waiting for approval for his chest surgery that he decided to save up his money and have the procedure performed at a private clinic. The private option for chest procedures is no longer available to transgender men in B. C.

Dara Parker, executive director of Vancouver’s QMUNITY queer resource centre, said that Flagg’s complaint draws attention to a gap between how the government perceives gender- reassignment surgery and other medically necessary procedures. “They’re life- affirming surgeries. Why aren’t they treated in the same way as a hip replacement or a heart transplant surgery?”

Health Ministry spokeswoman Kristy Anderson wrote in an email that she was unable to comment on Flagg’s complaint while it is before the tribunal.